Contraception and Family Planning Practice Questions

Q: Regarding the given mode of contraception, all statements are true EXCEPT?

It does not inhibit ovulation.. ***It does not inhibit ovulation*** - The **etonogestrel implant** (Nexplanon) **does inhibit ovulation** in approximately **97% of menstrual cycles**, making this statement false. - **Ovulation suppression** is the **primary mechanism** of contraceptive action for this subdermal implant. *It has the least failure rate* - The etonogestrel implant has a **failure rate of less than 1%**, making it one of the **most effective reversible contraceptives**. - It provides **continuous hormone release** without user compliance issues, contributing to its high effectiveness. *It contains etonogestrel* - The subdermal implant (Nexplanon) contains **68 mg of etonogestrel**, a **third-generation progestin**. - Etonogestrel is released continuously over **3 years**, providing consistent contraceptive efficacy. *It is effective for 3 years* - The **etonogestrel implant** provides contraceptive protection for **3 years** from insertion. - After 3 years, the implant must be **removed and replaced** if continued contraception is desired.

Q: Reversal of sterilization is best achieved by which method?

Falope ring application. The success of sterilization reversal (tubal re-anastomosis) is directly proportional to the amount of healthy fallopian tube preserved and the degree of tissue destruction. **Why Falope Ring is the Correct Answer:** The **Falope ring (Silastic band)** is a mechanical method of tubal occlusion. It works by looping a small segment of the fallopian tube and constricting it. This method causes **minimal tissue destruction** (usually only 1–2 cm of the tube). Because the remaining segments of the tube are healthy and long, surgical re-anastomosis has the highest success rate compared to other methods. **Analysis of Incorrect Options:** * **B. Cauterization:** This involves using bipolar or unipolar current to burn the tubes. It causes extensive thermal damage and lateral heat spread, destroying a large portion of the tube and making reversal difficult. * **C. Pomeroy Method:** This is the most common surgical method (ligation and excision). While it is relatively easy to reverse compared to cautery, it still involves the excision of a tubal segment, resulting in more tissue loss than a ring or clip. * **D. Irving Method:** This is a highly effective but aggressive surgical technique where the proximal end of the tube is buried in the myometrium. It is the most difficult to reverse due to the extensive surgical alteration of the anatomy. **NEET-PG High-Yield Pearls:** * **Best Reversibility:** Hulka-Clemens Clip > Falope Ring > Pomeroy Method. (Note: While clips are technically best, among the given options, the Falope ring is the superior choice). * **Most Common Method (India):** Modified Pomeroy’s technique. * **Failure Rate:** The Falope ring has a failure rate of approximately 0.2–0.5%. * **Prerequisite for Reversal:** A minimum of **4 cm** of healthy tubal length is ideally required for a successful pregnancy post-reversal.

Q: Oral contraceptive pills predispose to which of the following conditions?

Cerebral stroke. **Explanation:** The correct answer is **Cerebral stroke**. Combined Oral Contraceptive Pills (COCPs) contain estrogen, which has a significant impact on the coagulation profile. Estrogen increases the hepatic synthesis of clotting factors (II, VII, IX, X, and fibrinogen) and decreases natural anticoagulants like Antithrombin III and Protein S. This creates a **hypercoagulable state**, increasing the risk of thromboembolic events, including deep vein thrombosis (DVT), pulmonary embolism, and arterial events like myocardial infarction and **ischemic cerebral stroke**. The risk is significantly potentiated in women who smoke, are over 35 years old, or have underlying hypertension. **Analysis of Incorrect Options:** * **Asthma:** There is no established causal link between COCP use and the development or exacerbation of asthma. * **Peripheral neuropathy:** COCPs are not neurotoxic. In fact, some studies suggest B-vitamin supplementation may be needed for long-term users, but they do not predispose to neuropathy. * **Ovarian carcinoma:** This is a **protective effect**. COCPs significantly *reduce* the risk of ovarian and endometrial cancers by suppressing ovulation and thinning the endometrial lining. **High-Yield Clinical Pearls for NEET-PG:** * **Cancer Risks:** COCPs **increase** the risk of Cervical cancer and Breast cancer (slight), but **decrease** the risk of Ovarian, Endometrial, and Colorectal cancers. * **Benign Tumors:** COCPs are a known risk factor for **Hepatic Adenoma**. * **Absolute Contraindications:** Undiagnosed vaginal bleeding, history of thromboembolism, estrogen-dependent tumors, and smokers >35 years (>15 cigarettes/day).

Q: Which of the following natural family planning methods is most effective?

Symptothermal method. **Explanation:** The **Symptothermal method** is the most effective natural family planning (NFP) method because it is a **multi-index approach**. It combines multiple physiological markers of ovulation—specifically Basal Body Temperature (BBT), cervical mucus changes, and sometimes cervical position or calendar calculations—to identify the fertile window. By cross-referencing these indicators, the margin of error inherent in using a single parameter is significantly reduced, leading to a lower failure rate (Perfect use Pearl Index: ~0.4%). **Analysis of Incorrect Options:** * **Basal Body Temperature (BBT) method:** This relies on the 0.4–0.8°F rise in temperature caused by **progesterone** after ovulation. Its main drawback is that it only identifies the *end* of the fertile phase (post-ovulatory) and can be affected by fever, stress, or lack of sleep. * **Cervical Mucus Method:** This involves monitoring the changes in vaginal secretions. Under estrogen influence, mucus becomes thin, watery, and stretchy (**Spinnbarkeit phenomenon**). * **Billings Method:** This is a specific standardized version of the cervical mucus method. While effective, any single-index method (like A, B, or C) is statistically less reliable than the combined approach of the Symptothermal method. **High-Yield NEET-PG Pearls:** * **Pearl Index:** Defined as the number of unintended pregnancies per 100 woman-years of exposure. A lower index indicates higher efficacy. * **Lactational Amenorrhea Method (LAM):** Only effective for up to 6 months postpartum, provided the mother is exclusively breastfeeding and remains amenorrheic. * **Spinnbarkeit Test:** Refers to the elasticity of cervical mucus; maximum elasticity (10-12 cm) occurs just before ovulation. * **Standard Days Method:** Uses a "CycleBeads" string; it is only suitable for women with cycles between 26 and 32 days.

Q: What is the most commonly performed type of tubal ligation in current practice?

Pomeroy's method. ### Explanation **Pomeroy’s method** is the most commonly performed technique for tubal ligation worldwide, particularly in the postpartum period. Its popularity stems from its **simplicity, safety, and high efficacy**. The procedure involves grasping a loop of the fallopian tube (usually the isthmic portion), ligating the base with an absorbable suture (like plain catgut), and excising the loop. As the suture absorbs, the two ends of the tube fibrose and pull apart, creating a gap that prevents fertilization. **Analysis of Incorrect Options:** * **Irving’s operation:** This is the most effective method (lowest failure rate) but is technically difficult and requires extensive dissection. It involves burying the proximal end of the tube into the myometrium and the distal end into the broad ligament. * **Yoon ring application:** This is a mechanical method commonly used during **laparoscopic** tubal occlusion. While frequent in interval sterilization, it is not the "most common" overall compared to the Pomeroy technique used in both open and laparoscopic settings. * **Madlener procedure:** This involves crushing and ligating a loop of the tube without excision. It is rarely performed today because it has a high failure rate and carries an increased risk of tubal recanalization and ectopic pregnancy. **High-Yield Clinical Pearls for NEET-PG:** * **Most common method:** Pomeroy’s. * **Most effective method:** Irving’s (Failure rate ~0.1%). * **Failure rate of Pomeroy’s:** Approximately 0.1–0.5%. * **Ideal time for Postpartum Sterilization:** 24–48 hours after delivery. * **Site of ligation:** Usually the **isthmus** (the narrowest part). * **Modified Pomeroy:** Uses non-absorbable sutures (less common due to risk of fistula).

Q: What is the ideal contraceptive in the given scenario?

Oral contraceptive pill. ***Oral contraceptive pill*** - Provides excellent **contraceptive efficacy** (>99%) while offering dual benefits of **cycle regulation** and **hormonal balance** in young women with irregular cycles or PCOS. - Contains **estrogen and progestin** that help regulate menstrual cycles, reduce **dysmenorrhea**, and improve **acne** in reproductive-age women. *Intrauterine device (Cu-T)* - **Cu-T** may cause increased **menstrual bleeding** and **dysmenorrhea**, worsening existing menstrual irregularities. - Not ideal for young women with **heavy or irregular periods** as it can exacerbate these symptoms. *Barrier method* - Provides **lower contraceptive efficacy** (85-95%) compared to hormonal methods, requiring consistent proper use. - Offers **no hormonal benefits** for cycle regulation, dysmenorrhea relief, or management of conditions like PCOS. *Depot medroxyprogesterone acetate (Depo-Provera)* - Can cause **irregular bleeding** or **amenorrhea**, potentially masking underlying menstrual disorders in young women. - Associated with **bone density loss** and **weight gain**, making it less suitable for young women who need long-term contraception.

Q: What is the absolute contraindication for prescribing oral contraceptive pills in a woman of reproductive age group?

Congenital hyperlipidemia. **Explanation:** The correct answer is **Congenital hyperlipidemia**. Combined Oral Contraceptive Pills (COCPs) contain estrogen, which significantly impacts lipid metabolism. Estrogen increases the synthesis of triglycerides and VLDL in the liver. In patients with congenital hyperlipidemia, COCPs can trigger severe hypertriglyceridemia, leading to a high risk of **acute pancreatitis** and accelerating atherosclerosis, thereby increasing the risk of cardiovascular events. According to the WHO Medical Eligibility Criteria (MEC), known dyslipidemias are classified as **MEC Category 4** (absolute contraindication). **Analysis of Incorrect Options:** * **Epilepsy:** This is a **relative contraindication**. The primary concern is not safety, but efficacy; enzyme-inducing anti-epileptic drugs (like Phenytoin or Carbamazepine) increase the metabolism of OCPs, leading to contraceptive failure. * **Diabetes Mellitus:** It is a relative contraindication (**MEC 2/3**). OCPs can be used in diabetics without vascular complications. It becomes an absolute contraindication only if there is associated nephropathy, retinopathy, neuropathy, or if the duration of diabetes is >20 years. * **Hypertension:** It is a relative contraindication (**MEC 3**) if blood pressure is well-controlled (140–159/90–99 mmHg). It becomes an absolute contraindication (**MEC 4**) only if BP is ≥160/100 mmHg or if there is associated vascular disease. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications (MEC 4):** Smoker >35 years (≥15 cigarettes/day), History of DVT/PE, Ischemic heart disease, Stroke, Breast cancer (current), Migraine with aura, and Decompensated Cirrhosis. * **Best OCP for Lactating Mothers:** Progestogen-only pills (POPs), as estrogen suppresses lactation. * **Non-contraceptive benefit:** OCPs reduce the risk of Ovarian and Endometrial cancers.

Q: Which is the most likely complication of an IUD?

None of the above. **Explanation:** The correct answer is **None of the above** because the most common complications of an Intrauterine Device (IUD) are **increased menstrual bleeding (menorrhagia)** and **pelvic pain**. Since these are not listed among the options, "None of the above" is the most appropriate choice. **Analysis of Options:** * **A. Hypofibrinogenemia:** This is not a complication of IUD use. It is typically associated with obstetric emergencies like Abruptio Placentae, Amniotic Fluid Embolism, or prolonged Intrauterine Fetal Death (IUFD). * **B. Sterility:** IUDs do not cause permanent sterility. Fertility returns immediately upon removal. While Pelvic Inflammatory Disease (PID) can lead to tubal factor infertility, the risk is primarily limited to the first 20 days post-insertion due to pre-existing infection or poor aseptic technique, not the device itself. * **C. Cervical tear:** This is an extremely rare mechanical injury that might occur during a difficult insertion but is not considered a standard or likely complication of the device. **High-Yield NEET-PG Pearls:** 1. **Most common side effect:** Excessive menstrual bleeding (especially with Cu-T). 2. **Most common reason for removal:** Excessive bleeding and pain. 3. **Most common cause of IUD failure:** Expulsion (most common in the first year, during menstruation). 4. **Ectopic Pregnancy:** An IUD does not *cause* ectopic pregnancy, but if a woman becomes pregnant with an IUD in situ, the *likelihood* that the pregnancy is ectopic is higher compared to the general population. 5. **Perforation:** Most common during the act of insertion (incidence 1 in 1000).

Q: What is the primary mechanism of action of combined oral contraceptive pills?

Prevent release of ovum from the ovary. **Explanation:** The primary mechanism of action of Combined Oral Contraceptive Pills (COCPs) is the **inhibition of ovulation** (prevention of the release of the ovum). COCPs contain both estrogen and progestogen, which exert negative feedback on the hypothalamo-pituitary-ovarian axis. Estrogen primarily suppresses **FSH** (Follicle Stimulating Hormone), preventing follicular development, while progestogen suppresses the **LH** (Luteinizing Hormone) surge, which is essential for ovulation. **Analysis of Options:** * **Option A (Incorrect):** While COCPs do prevent fertilization as a secondary result of there being no egg, the *primary* physiological action occurs earlier in the cycle by halting ovulation. * **Option B (Correct):** As explained, the suppression of the LH surge prevents the ovary from releasing an egg. * **Option C (Incorrect):** This is a secondary mechanism. Progestogens cause endometrial atrophy, making the lining unreceptive, but this only occurs if ovulation and fertilization were to bypass the primary mechanism. * **Option D (Incorrect):** While progestogens thicken the cervical mucus to create a barrier for sperm penetration, they do not directly reduce the intrinsic motility of the sperm itself. **NEET-PG High-Yield Pearls:** 1. **Triple Action of COCPs:** 1) Inhibition of ovulation (Primary), 2) Thickening of cervical mucus (Hostile mucus), and 3) Endometrial atrophy (Prevents implantation). 2. **The "Mini-pill" (POPs):** Unlike COCPs, Progestogen-Only Pills primarily act by thickening cervical mucus; they do not consistently inhibit ovulation. 3. **Non-contraceptive benefits:** COCPs reduce the risk of ovarian and endometrial cancers, ectopic pregnancy, and benign breast disease. 4. **Failure Rate:** The Pearl Index for COCPs with perfect use is 0.1 per 100 woman-years.

Q: Which one of the following statements regarding the female contraceptive "Today" is true?

It is a polyurethane foam saturated with nonoxynol.. **Explanation:** **1. Why Option A is Correct:** "Today" is the brand name for a **vaginal contraceptive sponge**. It is a small, circular device made of **polyurethane foam** that is saturated with 1000 mg of **Nonoxynol-9**, a potent spermicide. It works through a triple mechanism: * **Chemical:** It releases the spermicide to kill sperm. * **Mechanical:** It acts as a physical barrier over the cervix. * **Absorption:** The foam absorbs the semen, preventing sperm from entering the cervical canal. It provides protection for up to 24 hours. **2. Why the Other Options are Incorrect:** * **Option B:** This describes a **Low-Dose Combined Oral Contraceptive Pill (COCP)**. While these are common, "Today" is a barrier method, not a hormonal pill. * **Option C:** This describes a **Standard-Dose COCP** (specifically a formulation like Ovral). The dosage of Ethinyl Oestradiol (0.3 mg) mentioned here is actually quite high/toxic; standard pills usually contain 0.03 mg (30 mcg). * **Option D:** **Gossypol** is a polyphenolic compound derived from cottonseed oil investigated as a **male contraceptive** (it inhibits sperm production). It is not used in "Today" and has been largely abandoned due to side effects like permanent infertility and hypokalemia. **3. NEET-PG High-Yield Pearls:** * **Nonoxynol-9:** It is a surfactant that destroys the sperm cell membrane. Note: It does **not** protect against HIV/STIs and may actually increase transmission risk by causing vaginal irritation. * **Toxic Shock Syndrome (TSS):** Users should be warned not to leave the sponge in for more than 30 hours due to the risk of TSS. * **Failure Rate:** The Pearl Index for the sponge is higher (approx. 12–24 per 100 woman-years) compared to OCPs or IUCDs, especially in parous women.

Question 1

Regarding the given mode of contraception, all statements are true EXCEPT?

Accepted Answer

It does not inhibit ovulation.

Answer

It has the least failure rate.

Answer

It contains etonogestrel.

Answer

It is effective for 3 years.

Question 2

Reversal of sterilization is best achieved by which method?

Accepted Answer

Falope ring application

Answer

Cauterization

Answer

Pomeroy method

Answer

Irving method

Question 3

Oral contraceptive pills predispose to which of the following conditions?

Accepted Answer

Cerebral stroke

Answer

Asthma

Answer

Peripheral neuropathy

Answer

Ovarian carcinoma

Question 4

Which of the following natural family planning methods is most effective?

Accepted Answer

Symptothermal method

Answer

Basal body temperature method

Answer

Cervical mucus method

Answer

Billings method

Question 5

What is the most commonly performed type of tubal ligation in current practice?

Accepted Answer

Pomeroy's method

Answer

Irving's operation

Answer

Yoon ring application

Answer

Madlener procedure

Question 6

What is the ideal contraceptive in the given scenario?

Accepted Answer

Oral contraceptive pill

Answer

Intrauterine device (Cu-T)

Answer

Barrier method

Answer

Depot medroxyprogesterone acetate (Depo-Provera)

Question 7

What is the absolute contraindication for prescribing oral contraceptive pills in a woman of reproductive age group?

Accepted Answer

Congenital hyperlipidemia

Answer

Epilepsy

Answer

Diabetes mellitus

Answer

Hypertension

Question 8

Which is the most likely complication of an IUD?

Accepted Answer

None of the above

Answer

Hypofibrinogenemia

Answer

Sterility

Answer

Cervical tear

Question 9

What is the primary mechanism of action of combined oral contraceptive pills?

Accepted Answer

Prevent release of ovum from the ovary

Answer

Prevent fertilization

Answer

Prevent implantation of a fertilized ovum

Answer

Reduce sperm motility

Question 10

Which one of the following statements regarding the female contraceptive "Today" is true?

Accepted Answer

It is a polyurethane foam saturated with nonoxynol.

Answer

It is an oral pill containing norethisterine acetate 1.0mg and ethinyl oestradiol 0.03 mg.

Answer

It is an oral pill containing D-norgesterel 0.50 mg and ethinyl oestradiol 0.3 mg.

Answer

It is made of gossypol, a derivative obtained from cottonseed oil.

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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